Temporal changes in the care and outcomes of elderly patients with acute myocardial infarction, 1987 through 1990

C. L. Pashos, J. P. Newhouse and B. J. McNeil
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115.

OBJECTIVE--To investigate changes between 1987 and 1990 in the care and outcomes associated with acute myocardial infarction (AMI) in elderly patients. DESIGN--Retrospective cohort study using a longitudinal database created from Medicare administrative files. PATIENTS--Cohorts comprising a total of 856,847 AMI patients insured by Medicare between 1987 and 1990. MAIN OUTCOME MEASURES--Annual rates of mortality at 30 days and 1 year following AMI, and the use of coronary angiography, coronary artery bypass graft surgery, and percutaneous transluminal coronary angioplasty during the first 90 days after a new AMI. RESULTS--Between 1987 and 1990, mortality rates decreased 10% overall from 26% to 23% at 30 days (P < .001) and from 40% to 36% at 1 year following AMI (P < .001). Declines in mortality and adjusted risks of 1-year mortality were similar in men and women and in blacks and whites, but mortality declines were more evident in those younger than 85 years. Meanwhile, the proportion of elderly AMI patients having angiography within the first 90 days after their index admission increased from 24% to 33% (P < .001); proportions increased for both genders and all races. The proportion of patients undergoing revascularization procedures increased from 13% to 21%; while rates of bypass surgery increased from 8% to 11%, rates of angioplasty doubled from 5% to 10% (all P < .001). CONCLUSIONS--Between 1987 and 1990, survival of elderly patients following AMI improved significantly. While changes in patient treatment may be responsible, the increased use of thrombolytic therapy appears to be only a partial explanation. Also, while the use of coronary angiography and revascularization procedures increased dramatically, the degree to which it caused the improvement in survival could not be determined.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Improvements in Long-Term Mortality After Myocardial Infarction and Increased Use of Cardiovascular Drugs After Discharge: A 10-Year Trend Analysis
Setoguchi et al.
J Am Coll Cardiol 2008;51:1247-1254.
ABSTRACT | FULL TEXT  

Reducing Post-Myocardial Infarction Mortality in the Elderly: The Power and Promise of Secondary Prevention
Boden and Maron
J Am Coll Cardiol 2008;51:1255-1257.
FULL TEXT  

Trends in Acute Myocardial Infarction in 4 US States Between 1992 and 2001: Clinical Characteristics, Quality of Care, and Outcomes
Masoudi et al.
Circulation 2006;114:2806-2814.
ABSTRACT | FULL TEXT  

Declining Mortality in Patients with Acute Renal Failure, 1988 to 2002
Waikar et al.
J. Am. Soc. Nephrol. 2006;17:1143-1150.
ABSTRACT | FULL TEXT  

Cost-effectiveness Analysis in the Assessment of Diagnostic Imaging Technologies
Gazelle et al.
Radiology 2005;235:361-370.
ABSTRACT | FULL TEXT  

Sex Differences in Use of Coronary Revascularization in Elderly Patients After Acute Myocardial Infarction: A Tale of Two Therapies
Rathore et al.
Chest 2003;124:2079-2086.
ABSTRACT | FULL TEXT  

Utilisation of coronary angiography after acute myocardial infarction in Ontario over time: have referral patterns changed?
Khaykin et al.
Heart 2002;88:460-466.
ABSTRACT | FULL TEXT  

Sex Differences in Cardiac Catheterization after Acute Myocardial Infarction: The Role of Procedure Appropriateness
Rathore et al.
ANN INTERN MED 2002;137:487-493.
ABSTRACT | FULL TEXT  

Trends in Acute Coronary Heart Disease Mortality, Morbidity, and Medical Care From 1985 Through 1997 : The Minnesota Heart Survey
McGovern et al.
Circulation 2001;104:19-24.
ABSTRACT | FULL TEXT  

Beneficial Effects of Vitamin E Treatment in Acute Myocardial Infarction
Sethi et al.
J CARDIOVASC PHARMACOL THER 2000;5:51-58.
ABSTRACT  

Temporal changes in the outcomes of acute myocardial infarction in Ontario, 1992-1996
Tu et al.
CMAJ 1999;161:1257-1261.
ABSTRACT | FULL TEXT  

Use of {beta}-blocker therapy in older patients after acute myocardial infarction in Ontario
Rochon et al.
CMAJ 1999;161:1403-1408.
ABSTRACT | FULL TEXT  

ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions
Scanlon et al.
J Am Coll Cardiol 1999;33:1756-1824.
FULL TEXT  

Use of Aspirin, {beta}-Blockers, and Lipid-Lowering Medications Before Recurrent Acute Myocardial Infarction: Missed Opportunities for Prevention?
McCormick et al.
Arch Intern Med 1999;159:561-567.
ABSTRACT | FULL TEXT  

Heart Failure Survival Among Older Adults in the United States: A Poor Prognosis for an Emerging Epidemic in the Medicare Population
Croft et al.
Arch Intern Med 1999;159:505-510.
ABSTRACT | FULL TEXT  

The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia
Shaw et al.
J Am Coll Cardiol 1999;33:661-669.
ABSTRACT | FULL TEXT  

Availability of Cardiac Technology: Trends in Procedure Use and Outcomes for Patients with Acute Myocardial Infarction
Wright et al.
Med Care Res Rev 1998;55:239-254.
ABSTRACT  

Electrocardiographic Changes and Mortality Due to Myocardial Infarction in Rats With or Without Imidapril Treatment
Ren et al.
J CARDIOVASC PHARMACOL THER 1998;3:11-21.
ABSTRACT  

Use of Cardiac Procedures and Outcomes in Elderly Patients with Myocardial Infarction in the United States and Canada
Tu et al.
NEJM 1997;336:1500-1505.
ABSTRACT | FULL TEXT  

Improved Outcome of Elderly Patients (>=75 Years of Age) With Acute Myocardial Infarction From 1981-1983 to 1992-1994 in Israel
Gottlieb et al.
Circulation 1997;95:342-350.
ABSTRACT | FULL TEXT  

Are the returns to technological change in health care declining?
McClellan
Proc. Natl. Acad. Sci. USA 1996;93:12701-12708.
ABSTRACT | FULL TEXT  

Rural Hospital Mortality for Myocardial Infarction in Medicare Patients in Illinois
Hand et al.
American Journal of Medical Quality 1996;11:135-141.
ABSTRACT  

Secular Trends in Coronary Atherosclerosis -- Analysis in Patients with Valvular Regurgitation
Enriquez-Sarano et al.
NEJM 1996;335:316-322.
ABSTRACT | FULL TEXT  

Recent Trends in Acute Coronary Heart Disease -- Mortality, Morbidity, Medical Care, and Risk Factors
McGovern et al.
NEJM 1996;334:884-890.
ABSTRACT | FULL TEXT  

Variation in the Use of Cardiac Procedures after Acute Myocardial Infarction
Guadagnoli et al.
NEJM 1995;333:573-578.
ABSTRACT | FULL TEXT  

Permanent Pacemaker Selection and Subsequent Survival in Elderly Medicare Pacemaker Recipients
Lamas et al.
Circulation 1995;91:1063-1069.
ABSTRACT | FULL TEXT  

DEATH RATES FALL AMONG ELDERLY WITH ACUTE MI
JWatch General 1993;1993:3-3.
FULL TEXT